Surgical versus percutaneous tracheotomy: a retrospective cohort study

Abstract Introduction Tracheotomy is a common procedure in intensive care patients requiring long-term mechanical ventilation. The need for this procedure increased during the COVID-19 pandemic. Two main techniques are used: surgical tracheotomy (ST) and percutaneous dilatation tracheotomy (PDT). It is unclear whether the choice of technique affects survival or blood gas parameters postoperatively. We aimed to compare 30-day survival and changes in arterial blood gases between patients who underwent ST and PDT during the COVID-19 pandemic. Method A retrospective cohort study was conducted at Södersjukhuset, Stockholm. A total of 139 patients with COVID-19-associated acute respiratory distress syndrome who underwent tracheotomy between 2020-03-07 and 2021-09-17 were included (73 ST, 66 PDT). The primary outcome was 30-day survival. Secondary outcomes included changes in pCO₂, pO₂ and pH before and after the procedure. Statistical analyses were performed using Student’s t-test and Fisher’s exact test. Result No significant difference in 30-day mortality was observed between the groups (26% ST vs 32% PDT, p = 0.358). The ST group had significantly higher postoperative pCO₂ (p = 0.047) and lower pH (p < 0.001) compared with PDT. Within the ST group, a significant increase in pCO₂ and decrease in pH were seen postoperatively. Discussion The choice of tracheotomy method did not affect 30-day survival. However, small but statistically significant differences were seen in blood gases, where ST was associated with poorer ventilation postoperatively compared to PDT. Since PDT and ST appear equivalent in terms of survival outcomes, the choice of technique should be guided by the patient’s clinical profile and the procedural context.